Evaluation of the impotent male.

Zafar Khan, MD

Beth Israel Medical Center, NYC.

Evaluation of the impotent male.

• Medical and Psychosexual history.

• Physical examination:– Nocturnal penile tumescence.– Neurologic testing.

• Sacral Evoked response.

• Genitocerebral Evoked response.

• Hormonal Testing.

Evaluation of the impotent male.

• Nocturnal penile tumescence testing (NPT):– To distinguish psycogenic from organic causes.– NPT occurs during REM sleep, 4 to 5 erectile

episodes per night, lasting longer than 30 min.– Increase of circumference greater than 3cm.– Increase of rigidity 70% of maximal.

Evaluation of the impotent male.

• Vascular Evaluation:– Pulsed Doppler analysis.– Duplex-Ultrasonography.

• Arteriography.

• Cavernosometry / Cavernosography.

Evaluation of the impotent male.

• Cavernosometry:– Injection of 10g PGE1.– Intracorporal pressure measurement (120mm

Hg).– Corporal infusion (maintainance 5ml/min).– Pressure decay (< 45mm/Hg in 30 sec).

• Cavernosography:– Infusion of contrast medium.

Evaluation of the impotent male.

• Neurological testing:– Biothesiometry:

• Sensory perception of vibratory stimulation.

– Sacral evoked response (BC reflex latency).• 30-40 mil/sec at 50 volts.

– Genitocerebral evoked potential studies:• Cerebral response to dorsal penile nerve stimulation.

Evaluation of the impotent male.

ZAFAR KHAN, M.D.Phone: 212-420-1566

www.aboutsexualdysfunctions.comwww.urologyandyou.comE-Mail: zafarkhan@urologyandyou.com